Cause of vasomotor symptoms - Forum

paulo

Cause of vasomotor symptoms - Ärzteforum

Post#1 »

About two months ago I started experiencing vasomotor symptoms,piloerection,vasodilatation,etc.At the beginning I did not worry at all and thought it was because of a cold or something like that,but the symptoms continued and worsened and because I had something similar about a year ago,one of my internist friends suggested I do myself an abdominal tomography. I did as I was told and the radiologist found a 3.9 per 2.9 left adrenal mass,no lymph nodes ,nothing more. The tomographic aspect is grease in the superficial layer and sort of cystic in the middle. Next I did myself a seric electrolyte test which turned normal and all the 24 hour urine tests of Vanililmandelic acid,total catecholamines,metanephrines,5 hidroxiindolacetic acid,dopamine,etc. All were normal except the vanililmandelic count which showed 9.5 mg in 24 hours. I went through a methayodine bencilguanetidine nucler medicine test which showed bilateral non intense captation of the radionuclid. It also showed left thoracic captation though not intense. The chief of nucler medicine told me that he thought that this were signs of bilateral adrenal hiperplasia and suggested a chest scan which I did and was normal. Because he thought that the methaiodine test was not conclusive he indicated the radiomarked ocreotide test which I started today.The first scan was normal but I have to go again tomorrow. I had about three weeks ago a hypertensive crisis,the only one I have had which I could control with Nifedipine.Have continued to have adrenegic syndrome though not very intense. Consulted an endocrine surgeon friend of mine who thinks I have a pheocromocytoma and suggests left laparoscopic adrenalectomy. My question:You think it is wise to do it laparoscopically or because of the right gland methaiodine captation I should undergo a formal laparotomy. I have to tell you that the abdominal CT Scan shows a normal right adrenal gland. So,this is the problem I am experiencing right now. I have to admit that Iam a little bit worried and also scared.


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Lady Surgeon

Re: Cause of vasomotor symptoms - Ärzteforum

Post#2 »

I attended the ACS course on minimally invasive surgery. There were a number of people doing laparoscopic bilateral adrenalectomy. Some do it using the prone position. Others do it using the lateral position, then reposition the patient for the other side. Their reason for not using the prone position is lack of familiarity with the procedure. If I were the patient, the only reason I would go for an open procedure would be if I couldn't find a surgeon facile with the laparoscopic approach.

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Treatment guru

Re: Cause of vasomotor symptoms - Ärzteforum

Post#3 »

Not totally convinced that the diagnosis is correct?

Chirurgia

Re: Cause of vasomotor symptoms - Ärzteforum

Post#4 »

First of all, and above surgical postings, my strongest support in this hard time.This is a time for you in wich you'll realize that the same good modern surgery that you practice now becames very useful for you. As far as I know, there's plenty of good and experienced lap surgeons in your country. About laparotomy and the right adrenal stuff, I personally wouldn't operate it. My last update in the Dr Gonzalez's international course of surgery in Madrid left me the idea of not to perform "profilactic" bilateral adrenalectomy (just treat the one bearing the tumor). Weighting prons and cons (adrenal insuf vs contralateral recurrence)that was the state of art.

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Billroth

Re: Cause of vasomotor symptoms - Ärzteforum

Post#5 »

Dr. J.S. sent us some notes collected by him at the last meeting of the ACS. One of those, that I have copied for you, is related with a movie shown about laparoscopic uni and bilateral adrenalectomy. As the clinical picture you describe has many characteristics of being a pheocromocitoma or a bilateral adrenal hyperplasia as you point out, perhaps you can get this movie from the ACS's library and see the procedure for yourself.

Jorjo

Re: Cause of vasomotor symptoms - Ärzteforum

Post#6 »

The presentation of your own case put me in a especial situation, I can't give you an objective opinion about your illness, nevertheless I feel able to say a few words. What you must do is to go to an specialist in lap adrenal surgery and from there on to behave as a patient, do what your surgeon thinks it would be the best for you. Please don't ask for public opinion, what for?, what are you going to get? I feel all the surgeons as if they are my friends, you are one of them, so my friend, I can send you my best wishes that you'll soon recover your health to keep on going with us in this long way of the search of the best for our patients, I guess that this should be the same feeling of all the Forum, but excuse my friend, for now I can't give you other opinion than the one I did.

bonjorno

Re: Cause of vasomotor symptoms - Ärzteforum

Post#7 »

Last laparoscopic removal of suprarenal mass was I'll tell:
A argentinioan surgeon operated a patient by a intestinal small bowell obstruction by old post op adhesion;in the normal post op period,the surgeon ask a CT abdominal scan for nobody knows reason.Surprise,a mass at the left or right,I do not remember exactly,suprarenal.Full image and laboratory exam.
The surgeon said to the patient:you need a resection of this tumor.Patient ask:by laparoscopic route?;the surgeon said,yes.Patient ask:how many patients do you have operated? Surgeons said : but,I know a well known surgeon in USA,so he can to operate you. That's fine,said the patient.
"2 act. The argentinian patient arrive to USA,and he is operatyed by laparoscopic route.FULL succeed."2 days at hospital,then to the Hotel,and at POD 6,return to buenos Aires.And the biopsye? Upp,said the surgeon,to day is confuse,but ,in a few days,I'll send you the final report.Do not worry.
3Act. Biopsy arrived to Buenos Aires:HYPERNEFROMA. So,the surgeons never knows exactly where he was working
4.Act. A argentinian urologic surgeon removed the kidney and the tumor of this patient...
5.Act.The first surgeon who reccomended the trip to Usa for laparoscopic remeval of suprarenal mass,to day remain as a pioneer of "advanced laparoscopic surgery".
So,sorry by the illness,but Open surgery is not dead.

Priya

Re: Cause of vasomotor symptoms - Ärzteforum

Post#8 »

I've been wondering about this recently. Somewhere in my training I got the idea that an abscess or a perforation needs immediate operation - you may run in some fluid and fix the potassium but you don't go home and sleep on it. I honestly wonder now - what's the damage done by sitting on a perforation or abscess for six hours? How about for 24 hours?

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